Question: Hello Doctor,
I am a physicist who is a diabetic (Lantus 93 units 2x per day and Humalog on a sliding scale), have mild high blood pressure corrected by taking 2 100mg Lopressor, 1 Lotrel 10/20 and 1 40mg Lasix per day. I've also been treated for the past 17 years for severe back pain due to a combination of degenerative disc disorder (all of my lumbar discs are now gone) and for moderate-to-severe osteoarthritis from T-4 to T-12. For this pain have been taking 4 hydrocodone 10mg -acetaminophen 325 per day for the last several months, and Lorcet 10 for 12.5 year prior to that. I take the NSAID Mobic 15mg once per day for the osteoarthritis, and 3 400mg Neurontin for mild-to-moderate neuropathy in my feet as well as the nerve pain which has developed in my back over the years. I am also being treated for adult ADHD and take Dexedrine 10mg tabs 3x per day for this.

My question to you regards developing circulation problems I've noticed in my feet lately which are almost certainly secondary to my diabetes. I was wondering if a calcium channel blocker such as nifedipine (Procardia)--which I realize is normally given for angina--a drug known to have a vasodilator action might be helpful for my problem, perhaps even prevent eventual need for amputation, if given in small doses. If this class of drugs seems contraindicated do you know of any pharmacological intervention that might work for my problem? Something that can be specific to the vessels in my lower legs and feet would (of course) be ideal, but I know of nothing like this and my extensive research has uncovered no promising drug along this line.

I would greatly like to avoid any surgical intervention to widen the blood vessels in my lower extremities if at all possible due to the many things that can go wrong with such procedures, not the least of which being blood clots that have a nasty habit of ending life quickly...

I thank you for your time Doctor.

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Thank you doctor. I will speak with my physician about the nifedipine cream. My control of my diabetes has been excellent, my last A1c was 5.3 and I have averaged about 5.8 for the past 10 years, but as we both know, diabetes sometimes pays little attention to solid control of one's blood sugars and the peripheral damages caused by this terrible metabolic disorder can occur even under the best of circumstances. My back problem makes physical activity problematic however as I currently need a cane to walk, and if I do so for farther than about a mile it has the potential (actually did twice) to land me in the hospital. As for physical therapy I will definitely arrange for this to start very soon. Who knows? Perhaps it might even help me with my back problem.

As a physicist I spend far too much time at my desk working with high level maths relating to M theory as it relates to cosmology thus adding to the problem. However, I've seen a small pedal device that fits under the desk and allows one to exercise their legs whilst sitting down and doing largely mental work. Do you think such a thing might be useful?

Once again I thank you for your time, and wish you well.

Warmest personal regards,

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